Patient Navigator
4 weeks ago
Summary
The Patient Navigator identifies needs and assists the multidisciplinary team in eliminating barriers to Rehabilitation care and discharge to the community. The Patient Navigators guide the patient/family from admission through discharged, and act as the central point of contact for the patient and the entire Rehabilitation team. The Patient Navigator requires excellent communication and organization skills.
The Patient Navigator coordinates the patient's care plan to assist with efficiency and quality of care delivered during the stay. The Patient Navigator is the patient/ families advocate providing supportive and personal assistance while serving as a liaison to ensure that patients/families receive resources and services as needed.
Essential Functions
- The Patient Navigator's will contact patients/families with in 48hrs after admission,
- Providing and coordinating proficient, evidence-based care, which includes evaluation, assessments, planning and implementing a comprehensive multidisciplinary plan of care.
- Every patient and family on admission is assessed for emotional and social needs.
- Every patient and family are assessed for barriers to care and discharge such as Health insurance, physical environment, transportation, caregiver support. Findings are to be documented and communicated with the multidisciplinary team to support a coordinated, appropriate length of stay and discharge to community.
- Patient Navigator will assist patient and family to access needed services at discharge through coordinating services and developing relationships with various providers.
- The Patient Navigator serves as a central resource to patients and families through communicating effectively with the physician, therapy and other department personnel.
- The Patient Navigator also provides education to patients about the diagnosis and treatment modalities in addition to the team members to facilitate learning and understanding.
- Patient Navigator works directly with patients, families to provided services within the continuum.
- The Patient Navigator serves as the primary liaison between the patient /family and the multidisciplinary care team, as well as external care providers. Facilitating communication through the stay and coordinating services necessary at discharge.
- The Patient Navigator participates as part of a multidisciplinary team in the reviewing of quality metrics in an effort to maximize our outcomes, specifically in relation to discharge to community, readmission. rates and length of stay.
- The Patient Navigator appropriately determines needs for patients at discharge and helps to coordinate service, DMF, Medication, remote monitoring including organizing services for home health care, outpatient therapies within the network.
- Patient navigator works closely with the team anticipating the needs of the patient and family at discharge, so as not to delay discharge and provide a safe discharge to the community.
- Patient Navigator must demonstrate excellent time management skills while following the standards of work developed; this includes completing documentation in such a manner after each contact to allow coordinated care with multiple disciplines during the patients stay. This clear and concise documentation is the corner stone for the team on discharge planning and care needs in preparation for education and a safe discharge home.
- Patient Navigator understands and helps patient complete necessary forms for financial assistance, Heath coverage and others to provide a safe discharge into the community.
- Other duties as assigned.
Requires thorough knowledge of rehabilitation principles and those of interdisciplinary team coordination. Excellent verbal and written communications skills needed. Working knowledge of community resources with facilitate care transitions. Requires management of multiple time sensitive tasks occurring simultaneously. Must be comfortable engaging with patients, families, and other disciplines to discuss complex discharge plans. Teamwork, imitative, and organization are key performance indicators.
Education and Experience
- Must demonstrate excellent time management skills, while adhering to standards of work
- Attention to detail, clear and concise documentation is critical.
- 2 years of experience working with interdisciplinary team in acute rehab or hospital setting
- Bachelor's degree in healthcare field required.
- RN/OT experience and licensure
Schedule: Monday-Friday and rotating on-call weekends
The Rehabilitation Hospital of Indiana is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, sexual orientation, or any other characteristic protected by law.
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